Provider Demographics
NPI:1073536561
Name:LANKIST, MATTHEW EDWARD (ARNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:LANKIST
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6374
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32447-6374
Mailing Address - Country:US
Mailing Address - Phone:850-326-1918
Mailing Address - Fax:
Practice Address - Street 1:4970 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6802
Practice Address - Country:US
Practice Address - Phone:850-718-5620
Practice Address - Fax:850-718-5670
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2899592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302183100Medicaid
FLY6876ZOtherBCBS
FLY6876ZMedicare PIN
FL302183100Medicaid